A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?

Correct Answer: A

Rationale: The correct answer is A: Helicobacterial infection. This is the most probable leading mechanism of disease development in this case because the patient's symptoms, such as heartburn, epigastric pain, food intolerance, and presence of a duodenal ulcer with a positive urease test, are classic signs of Helicobacter pylori infection. This bacterium colonizes the stomach lining, leading to inflammation and ulcer formation. The exacerbations in spring and autumn could be due to seasonal variations in immune response. Choice B: Dietary allergy is incorrect because the symptoms and findings in the patient are more indicative of an infectious etiology rather than an allergic reaction to specific foods. Choice C: Autoantibody production is unlikely as there are no indications of an autoimmune process in this case. Choice D: Reduced prostaglandin synthesis is not the leading mechanism as the symptoms and findings are more consistent with an infectious cause rather than a deficiency in prostaglandin synthesis.

Correct Answer: A

Rationale: The correct answer is A: Capsule. A capsule is a mucous structure tightly bound to the bacterial cell wall with distinct outer boundaries. This structure helps bacteria evade the host immune system, resist desiccation, and adhere to surfaces. In contrast, spores are resistant structures formed by certain bacteria for survival, filaments are long chains of bacterial cells, and ribosomes are cellular organelles responsible for protein synthesis. Therefore, based on the characteristics described in the question, the most appropriate choice is A: Capsule.

Correct Answer: B

Rationale: The correct answer is B because Q-fever is not transmitted only after ticks bite; it can also be transmitted through inhalation of contaminated aerosols. Rickettsia mooseri and Rickettsia provazekii can cause spotted fevers, making choice A correct. Mediterranean fever is associated with a recurrent pattern of fever, not maculopapular rash, making choice C incorrect. "None of the above" is not correct in this case as choice B is incorrect.

Correct Answer: B

Rationale: The correct answer is B: Yersinia pestis. Y. pestis is the causative agent of plague, a serious infectious disease transmitted through fleas. It causes bubonic, pneumonic, and septicemic plague. Bordetella pertussis causes whooping cough, Rickettsia prowazekii causes epidemic typhus, and Treponema pallidum causes syphilis. Y. pestis is the correct answer because it is specifically associated with plague, making the other options incorrect.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Aspergillus flavus is a fungus known to produce aflatoxin. 2. Aflatoxin is a potent carcinogen found in contaminated food. 3. Candida albicans is a yeast species not associated with aflatoxin production. 4. Claviceps purpurea is a fungus that produces ergot alkaloids, not aflatoxin. 5. Staphylococcus aureus is a bacterium known for causing food poisoning, not aflatoxin production. Summary: Aspergillus flavus is the correct answer as it is the organism known to produce aflatoxin, a carcinogenic substance. Other choices are incorrect as they are not associated with aflatoxin production.

Correct Answer: D

Rationale: The correct answer is D: Innate immunity (natural resistance). Innate immunity refers to the non-specific defense mechanisms that act against a variety of infectious agents. This includes physical barriers like skin and mucous membranes, as well as cellular components like phagocytes and natural killer cells. Adaptive immunity (A) is specific and involves the production of antibodies and immune memory (B), which are not part of the initial non-specific response. Antibodies (C) are part of the adaptive immune response and are produced in response to specific pathogens, not part of the non-specific innate defense factors.

Correct Answer: B

Rationale: The correct answer is B: EIEC. This strain of E. coli can cause bloody diarrhea in children similar to shigellosis due to its ability to invade and replicate within the intestinal epithelial cells, leading to inflammation and bloody stools. ETEC (A) causes watery diarrhea due to enterotoxins. EAEC (C) causes persistent diarrhea. EPEC (D) causes attaching and effacing lesions on the intestinal mucosa without invasion.

Correct Answer: B

Rationale: The correct answer is B: Helicobacter pylori. This bacterium is responsible for stomach acid formation by producing an enzyme called urease, which converts urea into ammonia and carbon dioxide, leading to an increase in stomach pH. Staphylococcus aureus (A) does not cause stomach acid formation. Bacillus cereus (C) and Clostridium botulinum (D) are not involved in stomach acid processes.

Correct Answer: C

Rationale: Step 1: Togaviridae is a family of viruses known to have non-segmented (+)ssRNA as their genetic material. Step 2: The positive sense RNA means that the viral RNA can be directly translated into proteins by host machinery. Step 3: This RNA genome acts as mRNA, allowing for immediate translation of viral proteins. Step 4: Therefore, choice C is correct as it accurately describes the genetic nature of Togaviridae. Summary: - Choice A is incorrect because Togaviridae viruses do not have helical symmetry. - Choice B is incorrect because Togaviridae viruses do not have non-segmented (-)dsRNA. - Choice D is incorrect because Togaviridae viruses are enveloped viruses.